Social Media: Examination of Renal Professional Practices and Guiding Principles

31 Social Media: Examination of Renal Professional Practices and Guiding Principles Lisa Hall, MSSW, LICSW, Northwest Renal Network The widespread use of technology and social networking websites, such as Facebook and Twitter, creates new avenues for renal professionals to share information. However, intentional or unintentional virtual contacts with patients and potential breaches of professional ethics are always possible. During a session at the NKF 2012 Spring Clinical Meetings in Washington, D.C., attendees discussed ethical dilemmas in this era of rapidly expanding social media, were polled regarding their practices, and expressed the need for further examination of the implications of new technologies for renal patients, professionals, and organizations. By seeking consultation with regard to ethics and reviewing professional, regulatory, and agency policies, health care professionals can stay on the safe side of social media. INTRODUCTION With limited control of who reads or follows social net- A recent post on the Council of Nephrology Social Workers working content, intentional and unintentional virtual professional email LISTSERV inquired about how social contacts between staff and patients are always possi- workers handle “Friend” requests on Facebook from ble. Some of the situations that may arise with new patients. This prompted a lively discussion of professional technology: emails between staff and patients; patients boundaries, dual relationships, and the need for further “Googling” (using the Google online search engine) staff; exploration of ethical practices and policies around this staff “Googling” patients; and issues of confidentiality and ever-changing social landscape (NKF CNSW LISTSERV, privacy. Information provided could be inadvertently used 2011). The purpose of this article is to examine the many to identify a patient. The ease of posting and the common- challenges faced by social workers related to social net- place nature of sharing information via social media may working, and to discuss some guiding principles. appear to blur the line between one’s personal and professional life. What is social media? Social media is the use of web-based technology that allows the exchange of user-generated Advantages of Social Media content. Facebook, the ubiquitous social networking util- There are numerous advantages to having social networking ity, presently has 1 billion users (Facebook, 2012). Twitter accounts. Information can be disseminated quickly and to a claims 140 million users (Bennett, 2012; Wasserman, 2012). large population at no cost. Social media is used for: The majority of national renal professional organizations, patient organizations, and dialysis corporations now utilize • A venue for online discussion of health-related topics Facebook and Twitter. and trends Facebook is a social networking service which requires • A bulletin board for posting upcoming events users to register before using the site, after which they may • Fostering professional connections create a personal profile, list other users as friends, and • Marketing exchange messages, including automatic notifications when they update their profile. For those who are unfamiliar with • Sending, receiving, and accepting social invitations Twitter, it is a microblogging service that allows users to • Sharing local, national, and international news send messages of up to 140 characters (“Tweets”) to recipi- • Forging ties with out-of-state family and friends ents known as “followers.” While on Facebook, both parties must agree to be friends; with Twitter, users have limited • Exercising humor and creativity control of who follows them. “Tweets” may be read by any- • Sharing and receiving information relevant to lives one, whether registered with Twitter or not. and interests Blogs are online journals written by one person or a group • Keeping up with professional trends and contacts of contributors, often focused on a specific field or specialty. Blogs permit writers to engage in conversations with read- • Participation in civic action, including advocacy and ers. There are many nephrology-related blogs, websites, public policy and LISTSERVs: patient-authored, physician-authored, and Renal Business Today (2010) featured the article “Social university-based. The term “LISTSERV” has been used to Media in Nephrology.” The director of communications for refer to electronic mailing list software applications, allow- DaVita provided comments in this article on social media: ing a sender to send one email to the list, which transpar- “This platform benefits doctors, caregivers, patients, and ently sends the email to all addresses subscribed to the list. their loved ones in several ways: patients can share experiences and benefit from industry information to improve Corresponding author: Lisa Hall, MSSW, LICSW, Northwest Renal Network, 4702 42nd Ave SW, Seattle, WA 98116; [email protected]; 206.923.0714, ext. 109. 32 Social Media their quality of life, loved ones can share experiences and • What happens when your patient discovers you have learn how they can offer better support, and the doctors/care 20 Facebook Friends in common? Will they wonder team members can learn first-hand what their patients are what you are sharing with these friends? looking for, giving them prime ways they can better their facilities—especially on a human level.” Dual relationships—The NASW Code of Ethics (NASW, 1996) stipulates that social workers should not engage in Risks Related to Social Networking dual or multiple relationships, with clients or former clients, in which there is a risk of exploitation or potential harm To understand the limits of appropriate use of social media, to the client. Accepting an invitation from a client to be a it is important to have an understanding of the risks faced by friend on Facebook (or other social network sites) creates a professionals. The National Association of Social Workers dual relationship. (NASW, 2005) and Association of Social Work Boards (ASWB) have developed the Standards for Technology and Effect on team-based patient care—Cyber-bullying, or the Social Work Practice to create a uniform document for the use of cell phones or other devices to send or post text or profession. The specific goals of the standards are: images intended to hurt or embarrass another person, is detrimental to a cohesive health care delivery team. For • to maintain and improve the quality of technology- example, a member of the interdisciplinary care team send- related services provided by social workers; ing “Tweets” about patients that are unprofessional in nature • to serve as a guide to social workers incorporating can result in a loss of therapeutic effectiveness, loss of technology into their services; objectivity, and exploitation. • to help social workers monitor and evaluate the ways Legal risks—What you learn about patients in social media technology is used in their services; and could become a legal issue. What if a patient were to tweet • to inform clients, government regulatory bodies, about being suicidal? Could you be professionally liable for insurance carriers, and others about the professional failing to prevent harm? standards for the use of technology in the provision NKF SCM12 “Social Media and Boundaries” of social work services. Session—Audience Response Results The discussion of risks below, based on that guide, is not Using audience response system technology, attendees at the meant to be exhaustive or to reflect the order of importance. NKF 2012 Spring Clinical Meetings session on May 12 in Washington, D.C. (Hall, 2012), were polled regarding their Confidentiality—Information that is shared with staff by personal and professional use of social media. Respondents patients, including patients’ identities, must remain confi- were a fairly even spread across ages, ranging from 20 to dential unless the patient authorizes release. This require- 70, with a few more attendees in their 20s (18 attendees, or ment could easily be violated through use of a website 30%). Ninety percent were social workers, 5% nurses, and designed for social networking. Users run the risk of violat- 5% were other renal professionals. Of those surveyed more ing patients’ privacy and confidentiality by disclosing too than 45% stated they used social media on a daily basis, and much information. Emails, LISTSERVs, social networking only 27% stated they never used social media. Interestingly, websites, tweets, and blogs are not private, and can easily the sample’s use of social networks highlighted the many be shared by the recipient with others. Even content that gray areas faced by renal professionals. Eleven percent has been deleted is accessible. Some examples of potential reported receiving a “Friend request” from patients, with privacy and confidentiality violations: 7% reporting they accepted the request. Thirteen percent • There is always the risk of disclosing too much thought it was acceptable to engage patients on social net- identifiable information. A mistaken belief is that works, depending on the situation, while 22% were uncer- it is acceptable to discuss or refer to patients if they tain what to do if a previous patient tried to “Friend” them are not identified by name, but referred to by a after treatment had been completed. nickname, room number, diagnosis, or condition. There are many doctors and facilities beginning to use social • If we “accept” a patient’s “Friend request” (for networking to expand

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